骨關節炎:減重可減少膝軟骨負擔


  【24drs.com】長久以來,醫師一直建議減重以緩解膝蓋骨關節炎(osteoarthritis,OA)的疼痛與不適,現在,有證據支持這項醫療建言。
  
  在一篇有112名肥胖成人的研究中,澳洲研究者發現,減重和脛骨內側軟骨量流失較少以及改善膝蓋功能有關,若體重增加則是有反效果。這些研究發現線上登載於2月11日風濕性疾病學誌。
  
  澳洲墨爾本Monash大學暨Alfred醫院的Andrew J. Teichtahl醫師等人寫道,這些結果認為,對於肥胖病人,體重變化對疾病相關之膝關節構造與功能有所影響;減重是幫助肥胖者減少他們的膝蓋症狀和有害之結構性變化的主要對策,另外,肥胖者也應避免體重增加。
  
  作者們指出,雖然最近的系統性回顧顯示減重手術或非手術之減重計畫可改善膝關節炎,但是還沒有確切證據。
  
  資深作者Alfred醫院肌肉關節主任Flavia Cicuttini博士表示,我們知道,脛骨軟骨越少時,膝蓋越痛,脛骨軟骨流失表示將來可能需要置換膝關節。
  
  她表示,骨關節炎是整個膝蓋的疾病,而關節軟骨流失是疾病嚴重度和惡化的訊號。我們知道,流失軟骨和膝蓋骨關節炎的嚴重度有關,可用X光測量,X光檢查結果越差表示脛骨軟骨越少。我們分析膝蓋軟骨,特別是脛骨軟骨,因為可讓我們以一種比X光更敏感的方式檢視膝蓋狀態。
  
  為瞭解體重變化對膝關節的影響,Teichtahl博士等人從減重計畫和社區其他來源招募112名肥胖成人(身體質量指數≧30 kg/m 2),檢視脛骨軟骨和膝蓋症狀的變化(平均追蹤2.3年),採用「West Ontario and McMaster Osteoarthritis Index (WOMAC)」進行評分。
  
  他們發現,體重相較於開始時的變化百分比和WOMAC的各項指標有關,包括疼痛(β功能,-1.8 mm;P < .01)、僵硬(β,-1.6 mm;P < .01)與功能(β,-6.9 mm;P < .01 )。
  
  這關聯屬於線性關係,體重減少每1%與脛骨內側軟骨容積流失減少1.2 mm 3有關,相對的,體重增加每1%和流失量增加1.2 mm 3有關。
  
  校正年紀、性別、身體質量指數、各次掃描之間的時間、開始時的軟骨量之後,多變項分析顯示依舊有此關聯。
  
  作者們指出,雖然研究只有包括肥胖成人,各種體型的人應該都存在有體重改變和膝蓋骨關節炎之間的關聯。
  
  Cicuttini博士表示,雖然有證據認為肥胖是髕骨股骨關節炎的風險因素,他們並未觀察到體重減少和髕骨軟骨量的顯著影響。
  
  她指出,這可能是因為部位空間較小,我們需要更多研究對象和更長的研究期間,以確認是否有效,而我們的研究量體還不足以確認效果。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=7053&x_classno=0&x_chkdelpoint=Y
  

Osteoarthritis: Weight Loss Takes a Load Off Knee Cartilage

By Neil Osterweil
Medscape Medical News

Clinicians have long recommended losing weight to help ease the pain and discomfort of knee osteoarthritis (OA), and now there is evidence to back up that bit of medical wisdom.

In a study of 112 obese adults, Australian investigators found that weight loss was associated with a lower amount of cartilage volume loss in the medial tibia and an improvement in knee symptoms, whereas further weight gain had the opposite effect. The findings were published online February 11 in the Annals of Rheumatic Diseases.

"These results suggest that in obese people, weight change has a potentially disease modifying effect on both knee joint structure and symptoms. While weight loss is an important primary management strategy in obese individuals to reduce their knee symptoms and deleterious structural changes, avoidance of further weight gain must also be a management goal in obese individuals," write Andrew J. Teichtahl, MD, from Monash University and Alfred Hospital in Melbourne, Australia, and colleagues.

The authors note that although recent systematic reviews have shown improvements in knee OA after bariatric surgery or a nonsurgical weight loss program, hard evidence for the effect has been hard to come by.

"We know that the less tibial cartilage there is, the more knee pain there is, and loss of tibial cartilage predicts the need for knee replacement," senior author Flavia Cicuttini, MD, PhD, head of the musculoskeletal unit at Alfred Hospital, told Medscape Medical News.

"Although OA is a disease of the whole joint, articular cartilage loss is the hallmark of disease severity and progression. We know that loss of cartilage correlates with the severity of knee OA as measured using X-ray, so the worse the X-ray the less tibial cartilage there is. We use knee cartilage, and specifically tibial cartilage, because it allows us to examine the state of the joint in a very sensitive way — far more sensitive than X-ray," she said.

To see how weight change may affect the knee joint, Dr. Teichtahl and colleagues recruited 112 obese adults (body mass index ? 30 kg/m 2) from weight loss programs and other sources in the community. They looked at change over time (mean follow-up, 2.3 years) in tibial cartilage volume and knee symptoms, as scored by the West Ontario and McMaster Osteoarthritis Index (WOMAC).

They found a relationship between percentage weight change from baseline and change in all subscales of the WOMAC index, including pain (β function, ?1.8 mm; P < .01), stiffness (β, ?1.6 mm; P < .01), and function (β, ?6.9 mm; P < .01 ).

The relationship appeared to be linear, with every 1% of weight loss associated with a 1.2 mm 3 decrease in the loss of medial tibial cartilage volume. Conversely, every 1% gain in weight was associated with 1.2 mm 3 increase in loss of volume.

The association held up in multivariate analysis adjusted for age, sex, body mass index, time between scans, and baseline cartilage volume.

The authors note that although the study included only obese adults, the relationship between weight change and knee OA is likely to be seen in people with various body types.

Dr. Cicuttini said that although there is evidence to suggest that obesity is a risk factor for patellofemoral OA, they did not see a significant effect of weight loss on patellar cartilage volume.

"It may be that if the effect is smaller in that compartment, we would need larger numbers and a longer time period to show an effect if there is one, and our study was not large enough to show smaller effects," she noted.

The study was supported by Monash University. The authors have disclosed no relevant financial relationships.

Ann Rheum Dis. Published online February 11, 2014.

    
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